THE PANCREAS IN PRIMARY BILIARY-CIRRHOSIS AND PRIMARY SCLEROSING CHOLANGITIS

Abstract

In patients with primary biliary cirrhosis, the chronic cholestasis, salivary and lacrimal hyposecretion suggest that the disease is a dry gland syndrome. To determine whether or not pancreatic damage occurs in primary biliary cirrhosis and other forms of chronic cholestasis, pancreatic structure and function in primary biliary cirrhosis, and primary sclerosing cholangitis were studied. In a retrospective study, retrograde pancreatograms were abnormal in 43% of 35 patients with primary biliary cirrhosis, and 15% of 20 patients with primary sclerosing cholangitis (P < 0.02). In a prospective study, serum pancreatic isoamylase was abnormal in 56% of 41 patients with primary biliary cirrhosis and 36% of 22 patients with primary sclerosing cholangitis (NS), indicating pancreatic damage in both diseases. After secretin-pancreozymin stimulation, patients with primary biliary cirrhosis, but not patients with primary sclerosing cholangitis, showed a significant reduction in duodenal juice flow rate (P < 0.01) and immunoreactive trypsin output (P < 0.01). The reduced trypsin output in patients with primary biliary cirrhosis indicates pancreatic hyposecretion. In neither patients with primary biliary cirrhosis nor patients with primary sclerosing cholangitis was the immunoreactive trypsin concentration, or tryptic activity in duodenal juice, significantly different from controls. Pancreatic involvement in primary biliary cirrhosis is closely associated with Sjogrens syndrome and it is likely that the pancreatic hyposecretion is a component of the sicca complex. This association was not obvious in primary sclerosing cholangitis.